Balance Control in Patients with Subacute Non-Specific Low Back Pain, with and without Lumbar Instability: A Cross-Sectional Study

Abstract

Background

Patients with low back pain (LBP) have poorly coordinated neuromuscular control, which may alter the normal postural stability of the spine. Altered movement control may occur at any stage of LBP.

Purpose

(1) To identify differences in balance control and proprioceptive sense between subacute non-specific LBP (NSLBP) patients with and without lumbar instability (LI) and healthy subjects and (2) to investigate the correlation between factors of motor control deficits and balance.

Patients and Methods

Thirty-six participants matched by gender, age, and body mass index (BMI) were allocated into three groups of 12: subacute NSLBP patients with LI, subacute NSLBP patients without LI, and healthy subjects. Balance, proprioceptive sense, pain, functional disability, and fear of movement were evaluated.

Results

Subacute NSLBP patients with LI exhibited greater impairments in balance control, proprioceptive sense, and functional ability than patients without LI (p<0.05). Subacute NSLBP patients showed more impairments in balance control, proprioceptive sense, and fear of movement than healthy subjects (p<0.001), with the following effect sizes (partial η²) for static balance on stable and unstable surface: 0.597 and 0.560, anticipatory balance: 0.417, and dynamic balance: 0.536; proprioceptive sense: 0.676; and fear of movement: 0.379. Significant fair correlations were found between (1) static balance and proprioceptive sense, functional disability, and fear of movement; (2) functional reach test (FRT) and pain; and (3) the five times sit to stand test (FTSTS) and functional disability.

Conclusion

Subacute NSLBP patients with LI showed greater impairment in balance control than patients without LI. Reduced proprioceptive sense, increased pain, functional disability, and fear of movement were fairly related to impaired balance.

Keywords:

• motor control
• joint repositioning error
• non-specific low back pain
• instability

Data Sharing Statement

The authors will allow sharing of deidentified participant data, about balance and proprioception. The data will be available for anyone who wishes to access the data for any purpose. The data will be accessible immediately following publication, and within six months of the publication date. Contact should be made via the principal investigator [email protected].

Ethics and Consent Statement

This study was approved by the Ethics Committees for human research of the Khon Kaen University (Thailand) and the University of Public Health (Myanmar) in accordance with the Declaration of Helsinki. The study was registered at clinical trials.in.th (registration number: TCTR20180829002). All eligible participants were provided with an explanation about the objectives and procedures of the study and were asked to sign an informed consent form prior to commencing the study.

Acknowledgments

The authors thank the participants for their willingness to participate in this study, Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), and Khon Kaen University, Khon Kaen, Thailand for providing the research funding.

Author Contributions

All the authors of this study contributed based on the substantial contributions to conception and design, data acquisition, or data analysis and interpretation; drafting the article or critically revising it for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of the work are appropriately investigated and resolved.

Disclosure

All of the authors report they have no conflicts of interest in this work.